Provider Demographics
NPI:1982945291
Name:IANACONE, MARGARET ANNE (LAC)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:ANNE
Last Name:IANACONE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 FRESH POND LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-2364
Mailing Address - Country:US
Mailing Address - Phone:631-667-4423
Mailing Address - Fax:
Practice Address - Street 1:35 FRESH POND LN
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-2364
Practice Address - Country:US
Practice Address - Phone:631-667-4423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00488901171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist